Contractors License Application

This form has been modified since it was saved. Please review all fields before submitting.

Company Name*

Phone Number*

Contact Name*

Secondary Phone Number

Company Address*

City*

State*

Zip Code*

Email

Type of Work*

Bituminous Paver $100.00

Electrician $100.00

Excavator $100.00

General Contractor $100.00

HVAC $100.00

Landscape/Paver $100.00

Mason/Concrete $100.00

Mechanical $100.00

Plumber (055)

Plumber (other) $100.00

Roofer $100.00

Sewer $100.00

Waste Hauler $300

Other

Plumbers

Plumbers must submit a current State of Illinois Department of Public Health License (055 License).

For Other Please Specify Type

If you have a current State of Illinois license, please provide the type and license number

Surety Bond*

Upload signed copy of $10,000 Surety Bond in the name of the Village of Riverside. A signed original will need to be sent to the Village Offices.

Certificate of Insurance*

Upload a copy of your Certificate of Insurance with the Village of Riverside named as certificate holder. (Proof of worker's compensation should be indicated if required by the State.)

Worker's Compensation

I certify that I am not required by the State of Illinois to carry worker's compensation insurance (sole proprietor, S corp, etc.)

State/Local License*

Upload a copy of your state or local licenses (i.e. electric, 055 or roofing)

Payment

The $100 licensing fee must be received by the Village Offices before the license can be issued. Please contact the office with any questions.

Payment Options*

Please select a payment option. At this time, the Village cannot accept payment over the web or phone. Plumbers - there is no payment required.

Letter of Intent

If you are a subcontractor for a larger project, please upload your signed letter of intent. This form is not intended for building permit applications.

Note

There is a penalty for starting any work without a current contractor's license and/or building permit no less than double the cost of the permit.

Electronic Signature Agreement*

I hereby agree to comply striclty with all applicable codes and ordinances of the Village of Riverside, during the course of work and have submitted a $10,000.00 Surety Bond naming the Village of Riverside and a Certificate of Insurance with the Village named as an additional certificate holder.

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.